Center for Health Policy & Research (chpr)
University of Massachusetts Medical School
December 2005
MassHealth Managed Care
HEDIS® 2005
FINAL REPORT
Prepared by:
Center for Health Policy and Research (CHPR)
in collaboration with the Office of Acute and Ambulatory Care (OAAC)
and the MassHealth Behavioral Health Program (MHBH)
Project Team
Center for Health Policy and Research
Greg Leung
Rebecca Ouellette
Office of Acute and Ambulatory Care
Louise Bannister
Marlene Kane
Amina Khan
Ella Litvak
Susan Maguire
Mary Ann Mark
Liza Rudell
David Tringali
Kate Willrich-Nordahl
MassHealth Behavioral Health Program
John DeLuca
Office of Clinical Affairs
Ann Lawthers
Table of Contents
Executive Summary 2
Introduction 5
Organization of the MassHealth Managed Care HEDIS 2005 Report 7
Health Plan Profiles 9
Data Collection and Analysis Methods 12
Staying Healthy
Breast Cancer Screening 16
Cervical Cancer Screening 20
Prenatal and Postpartum Care 22
Frequency of Ongoing Prenatal Care 26
Adults’ Access to Preventive/Ambulatory Health Services 28
Getting Better
Appropriate Treatment for Children with Upper Respiratory Infection 34
Living With Illness
Controlling High Blood Pressure 38
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment 42
Follow-up After Hospitalization for Mental Illness 46
Antidepressant Medication Management 50
Appendix A: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment– Age-Stratified Results 55
Appendix B: Select PCC Plan Data by Eligibility Type 59
Appendix C: PCC Plan Data with and without the Essential Population 63
References 67
Executive Summary
Background
The MassHealth Managed Care HEDIS® 2005 Report presents information on the quality of care provided by the five health plans serving the MassHealth managed care population (Boston Medical Center HealthNet Plan, Fallon Community Health Plan, Neighborhood Health Plan, Network Health and the Primary Care Clinician Plan). This assessment was conducted by the Center for Health Policy and Research
(CHPR), the MassHealth Office of Acute and Ambulatory Care (OAAC) and the
MassHealth Behavioral Health Program (MHBH) by using a subset of HEDIS (Health
Plan Employer Data and Information Set) measures. HEDIS has been developed by the
National Committee for Quality Assurance (NCQA) and is the most widely used set of standardized performance measures to measure and report on the quality of care delivered by health care organizations. Through this collaborative project, CHPR, OAAC, and MHBH have been able to evaluate a broad range of clinical and service areas that are of importance to MassHealth members, policy makers and program staff.
Measures Selected for HEDIS 2005
For the HEDIS 2005 project, the MassHealth measurement set focuses on staying healthy (e.g., breast and cervical cancer screening, prenatal and postpartum care, and adult access to ambulatory and preventive health services), getting better (e.g., treatment of upper respiratory infection in children), and living with illness (e.g., controlling high blood pressure, treatment for alcohol and drug dependency, follow-up after hospitalization for mental illness, and antidepressant medication management).
Summary of Overall Results
Results from the MassHealth Managed Care HEDIS 2005 project demonstrate that MassHealth plans performed well overall when compared to other Medicaid plans around the country. For the purpose of this report, we conducted tests of statistical significance and compared the performance of the individual MassHealth plans with that of the top 25% of all Medicaid plans in the country (represented by the national Medicaid 75th percentile). For some measures such as Breast and Cervical Cancer Screening, Appropriate Treatment for Children with Upper Respiratory Infection, and Adults’ Access to Ambulatory and Preventive Health Services, MassHealth plans generally reported rates that are significantly better than or no different from the national Medicaid 75th percentile. Results were mixed for other measures such as Prenatal and Postpartum Care and Antidepressant Medication Management. For these measures, fewer plans reported rates that were significantly better than or no different from the Medicaid 75th percentile. One measure, Follow-up after Hospitalization for Mental Illness, yielded results with significant variation across the plans. It is not known whether the cause of this variation is a true difference in quality or some other factor such as differences in the demographic characteristics and health status of the populations served by the plans. Performance on new measures was encouraging, particularly on the Appropriate Treatment for Children with Upper Respiratory Infection, for which four plans reported rates that were significantly better than the national Medicaid 75th percentile.
MassHealth HEDIS 2005 Highlights
* MassHealth plans performed well overall when compared to Medicaid plans throughout the U.S.
* Some plans performed significantly better than or no different from the national Medicaid 75th percentile on measures such as breast and cervical cancer screening, treatment for children with upper respiratory infection, and adults’ access to ambulatory and preventive health services. The national Medicaid 75th percentile represents a level of performance that was exceeded by only the top 25% of all Medicaid plans in the U.S.
* Results for some measures, such as prenatal and postpartum care and antidepressant management, were mixed.
* There was wide variation among some plans for certain measures, including the Follow-up after Hospitalization for Mental Illness measure. The cause of this variation is not known but one factor may be differences in demographic and health characteristics in the populations served by the plans.
Executive Summary (continued)
Breast and Cervical Cancer Screening
*For breast cancer screening, all five MassHealth plans performed significantly better than the national Medicaid 75th percentile.
*One plan reported a HEDIS 2005 breast cancer screening rate that was significantly better than the plan’s own HEDIS 2003 rate.
*For cervical cancer screening, all five MassHealth plans performed significantly better than the national Medicaid 75th percentile.
*All five plans reported HEDIS 2005 cervical cancer screening rates that were not significantly different from their 2003 rates.
Prenatal and Postpartum Care/Frequency of Ongoing Prenatal Care
*Three plans performed significantly better than the national Medicaid 75th percentile on the timeliness of prenatal care measure.
*One plan’s rate for the timeliness of prenatal care measure was significantly better than its HEDIS 2003 rate.
*Performance on the postpartum visit rate was lower than that on the prenatal care measure. No MassHealth plan performed better than the national Medicaid 75th percentile, although two plans had rates that were not significantly different from the benchmark.
*All five plans had HEDIS 2005 rates that were not significantly different from their HEDIS 2003 rates.
*Three plans performed significantly better than or no different from the national Medicaid 75th percentile on the frequency of ongoing prenatal care measure.
Adults’ Access to Ambulatory and Preventive Health Services
*Four plans had rates that were significantly better than or no different from the national Medicaid 75th percentile for both the 20-44 and 45-64 age groups.
*Comparisons were not made to previous plan performance because this measure was last reported by MassHealth plans in 1997.
Appropriate Treatment for Children with Upper Respiratory Infection
*This was a new measure for the MassHealth plans.
*Four of the MassHealth plans performed significantly better than the national Medicaid 75th percentile.
Controlling High Blood Pressure
*This was a new measure for the MassHealth plans.
*Four plans reported rates that were not significantly different from the 75th percentile.
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
*This was a new measure for the MassHealth plans.
*For the Initiation rate, three plans reported rates that were significantly better than or no different from the national Medicaid 75th percentile.
*For the Engagement rate, all five plans reported rates that were significantly better than or no different from the national Medicaid 75th percentile.
Follow-up after Hospitalization for Mental Illness
*For both the 7-day and 30-day follow-up rates, four plans reported rates that were significantly better than or no different from the national Medicaid 75th percentile.
*Three plans reported rates that were significantly better than their 2003 rates for both the 7-day and 30-day follow-up rates.
Antidepressant Medication Management
*For the Optimal Practitioner Contacts rate, three plans had rates that were significantly better than or no different from the national Medicaid 75th percentile.
*For the Effective Acute Phase measure, two plans reported rates that were not significantly different from the national Medicaid 75th percentile.
For the Effective Continuation Phase rate, one plan reported a rate that was not significantly different from the national Medicaid 75th percentile.
*Performance since 2003 was mixed. For all three measures, MassHealth plans generally reported rates that were significantly lower than or no different from than their HEDIS 2003 rates, indicating room for improvement.
Summary of MassHealth Managed Care HEDIS 2005 Results
(Original document contains graph)
Introduction
Purpose of the Report
This report presents the results of the MassHealth Managed Care HEDIS 2005 project. This report was designed to be used by MassHealth program managers and by managed care organization (MCO) managers to identify plan performance on select HEDIS measures, compare performance with that of other plans and with national benchmarks, identify opportunities for improvement, and set quality improvement goals.
Project Background
Since 2001, the Center for Health Policy and Research (CHPR) has collaborated with the MassHealth Office of Acute and Ambulatory Care (OAAC) and the MassHealth Behavioral Health Program (MHBH) to conduct an annual assessment of the performance of all MassHealth managed care organizations (MCOs) and the Primary Care Clinician (PCC) Plan, the primary care case management program administered by the Executive Office of Health and Human Services (EOHHS). CHPR, OAAC and MHBH conduct this annual assessment by using a subset of HEDIS measures. Developed by the National Committee for Quality Assurance (NCQA), HEDIS is the most widely used set of standardized performance measures to measure and report on the quality of care delivered by health care organizations. HEDIS includes clinical measures, as well as measures of access to care and utilization of services.
The measures selected for the MassHealth Managed Care HEDIS 2005 project assess the performance of the five MassHealth plans that provided health care services to MassHealth managed care members during the 2004 calendar year. The five MassHealth plans included in this report are the Primary Care Clinician Plan (PCCP), Neighborhood Health Plan (NHP), Network Health (NH), Fallon Community Health Plan (FCHP), and Boston Medical Center HealthNet Plan (BMCHP). Descriptive information about each health plan can be found in the Health Plan Profiles section on page 9.
MassHealth HEDIS 2005 Measures
MassHealth selected ten measures for the HEDIS 2005 project. The ten measures included in this report assess health care quality in three key areas: clinical quality, access and availability of care, and use of services.
The clinical quality measures included in this report provide information about preventive services, up-to-date treatments for acute illness, management of chronic illness, and appropriate testing and screening. The specific topics evaluated in this report are breast and cervical cancer screening, controlling high blood pressure, follow-up after hospitalization for mental illness, antidepressant medication management, and appropriate treatment for children with upper respiratory infection.
The access and availability of care measures included in this report provide information about the ability of members to get the basic and important services they need. The specific topics evaluated in this report include prenatal and postpartum care, adult access to preventive and ambulatory health services, and initiation and engagement of alcohol and other drug dependence treatment.
Use of service measures provide information about what services the health plan provides to its members. The use of services is affected by member characteristics such as age, sex, current medical condition, and socioeconomic status, all of which could vary across plans. The only use of service measure included in this report provides information on the frequency of ongoing prenatal care.
Note: MassHealth measures member satisfaction through biennial administration of the Consumer Assessment of Health Plans (CAHPS®) survey. Results of the MassHealth CAHPS measurement effort can be found in the biennial MassHealth CAHPS report produced by CHPR in collaboration with the UMASS Center for Survey Research (CSR).
Organization of the MassHealth Managed Care HEDIS 2005 Report
This report presents the results of the MassHealth Managed Care HEDIS 2005 project in three sections. The three sections are based on consumer reporting domains created by the Foundation for Accountability (FACCT). The FACCT domains group clinical and access HEDIS measures with similar characteristics and are used in many national and regional health plan report card projects.
DOMAIN
DEFINITION
MEASURES SELECTED BY MASSHEALTH FOR HEDIS 2005 REPORTING
Staying Healthy
These measures provide information about how well a plan provides services that maintain good health and prevent illness.
* Breast Cancer ScreeningCervical Cancer ScreeningPrenatal and Postpartum CareFrequency of Ongoing Prenatal CareAdults’ Access to Preventive and Ambulatory Health Services
Getting Better
These measures emphasize how well a plan helps people recover from illness.
* Appropriate Treatment for Children with Upper Respiratory Infection
Living with Illness
These measures provide information about how well a plan helps people manage chronic illness.
* Controlling High Blood Pressure
* Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
* Follow-up After Hospitalization for Mental Illness
* Antidepressant Medication Management
Getting Better
These measures emphasize how well a plan helps people recover from illness.
* Appropriate Treatment for Children with Upper Respiratory Infection
Living with Illness
These measures provide information about how well a plan helps people manage chronic illness.
* Controlling High Blood Pressure
* Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
* Follow-up After Hospitalization for Mental Illness
* Antidepressant Medication Management
Separate data charts and supporting text have been added to the report for three measures— Adults’ Access to Preventive and Ambulatory Health Services, Initiation and Engagement of Alcohol and Other Drug Dependence Treatment, and Follow-up After Hospitalization after Mental Illness—in order to present PCC Plan data with and without the Essential population. For more information on this analysis, see page 11 of this report.
This report also includes three appendices that provide more detailed results.
(The original document contains chart.)
* Appendix A includes age-stratified results for the Initiation and Engagement of Alcohol and Other Drug Dependency Treatment measure.
* Appendix B presents coverage type break-outs for the PCC Plan for three behavioral health-related measures. The coverage types included in the breakouts are Basic, Essential and non-Basic/non-Essential.
* Appendix C presents data on the PCC Plan rates with and without the Essential population.
The schematic on the next page provides an overview of the template for reporting results for each measure.
Organization of the MassHealth Managed Care HEDIS 2005 Report
(Original document contains graph)
Name of measure
Information on the relevance of each measure
Statistical summary comparing plan rates to comparison rates named at the top of each column. 2005 rate is significantly below the comparison rate. 2005 rate is not significantly different from the comparison rate. 2005 rate is significantly above the comparison rate.
Individual HEDIS 2005 plan data including numerator, denominator, reported rate, and upper and lower confidence intervals
Benchmarks including national Medicaid 75th and 90th percentiles, national Medicaid mean, Massachusetts Commercial mean, and MassHealth weighted mean and median
Comparison of plan rates with the national Medicaid benchmarks and Massachusetts Commercial benchmarks. The black bars are the various benchmarks. The white bars represent rates that are significantly above the national Medicaid 75th percentile. The grey bars represent rates that are not significantly different from the national Medicaid 75th percentile. Bars with diagonal lines represent rates that are significantly below the national Medicaid 75th percentile.
Analysis of results, including the factors influencing performance and opportunities for improvement
Comparison data from HEDIS 2003, if available
Health Plan Profiles
MassHealth managed care plans provide care to over 600,000 Massachusetts residents. The MassHealth Managed Care HEDIS 2005 report includes data from five MassHealth plans serving members enrolled in managed care. This report does not reflect care provided to MassHealth members receiving their health care services outside of the five managed care plans. The following profiles provide some basic information about each plan and its members. The data chart on the next page provides a statistical summary of the demographic characteristics of each plan’s population.
Primary Care Clinician Plan (PCCP)
* Primary care case management program administered by EOHHS.
* Statewide managed care option for MassHealth members eligible for managed care.
* 311,687 MassHealth members as of December 31, 2004.
* Provider network includes group practices, community health centers, hospital outpatient departments, and individual practitioners.
* Behavioral health services are managed through a carve-out contract with the Massachusetts Behavioral Health Partnership (MBHP).
Neighborhood Health Plan (NHP)
* Non-profit managed care organization that serves primarily Medicaid members.
* 95,936 MassHealth members as of December 31, 2004.
* Primary service areas are Greater Boston, Lawrence, Lynn, Quincy, Revere, Brockton, and Worcester.
* Provider network includes mostly community health centers in addition to Harvard Vanguard Medical Associates, group practices and hospital-based clinics.
* Behavioral health services are managed through a carve-out contract with Beacon Health Strategies.
Network Health (NH)
* Medicaid-only provider-sponsored health plan owned and operated by Cambridge Health Alliance.
* 65,658 MassHealth members as of December 31, 2004.
* Primary service areas are Cambridge, Somerville, Arlington, Malden, Revere, Worcester, Gardner-Fitchburg, Lawrence, Lowell, Southbridge and Springfield.
* Provider network includes community health centers, group practices, hospital outpatient departments, and individual practitioners
* Behavioral health services are provided by Network Health providers.
Fallon Community Health Plan (FCHP)
* Non-profit managed care organization that serves the commercial, Medicare, and Medicaid populations.
* 8,536 MassHealth members as of December 31, 2004.
* Primary service areas are Worcester, Gardner-Fitchburg, Southbridge, and Framingham.
* Behavioral health services are managed through a carve-out contract with Beacon Health Services.
* Provider network for MassHealth members is exclusively through Fallon Clinic sites.
Boston Medical Center HealthNet Plan (BMCHP)
* Medicaid-only provider-sponsored health plan, owned and operated by Boston Medical Center, the largest public safety-net hospital in Boston.
* 126,220 MassHealth members as of December 31, 2004.
* Primary service areas are Springfield, Boston, New Bedford, Brockton, Fall River, Holyoke, Pittsfield and Westfield.
* Provider network includes community health centers, hospital outpatient departments, and group and individual practices.
* Behavioral health services are provided by BMCHP providers.
Differences in Populations Served by MassHealth Plans
Demographic characteristics and membership health status, including factors such as age, gender, geographic residence and disability status, vary across the five plans. These variations are most visible in the differences between the four MCOs and the PCC Plan. The overall physical and mental health of a plan’s members (including disability status) may influence a plan’s HEDIS performance. Because HEDIS measures are not designed for case-mix adjustment, rates presented here do not take into account the medical and mental health status of the members included in the measures.
The data on the next page describe each plan’s population in terms of age, gender, disability status, and use of Department of Mental Health services (a proxy for mental health status). It is important for readers to consider the differences in the characteristics of each plan’s population when reviewing and comparing the HEDIS performance of the five plans.
Health Plan Profiles: Demographic Characteristics of the Plan Populations
(Original document contains graph)
* These data represent the percentage of members who are served by the Massachusetts Department of Mental Health (DMH). These data are a proxy for mental health status.
Statistically Significant Differences Among the Plans
Female: All four MCOs have a significantly higher proportion of female members than the PCC Plan (p